- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.23 / $1,130.47 / $2,250.00
| Facility | | $467.23 | $1,130.47 | $2,250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.88 / $618.01 / $1,130.47
| Professional | | $270.88 | $618.01 | $1,130.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,917.46 / $9,584.71 / $12,894.52
| Facility | | $7,917.46 | $9,584.71 | $12,894.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,876.19 / $14,377.08 / $19,341.77
| Facility | 50 | $11,876.19 | $14,377.08 | $19,341.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.83 / $596.41 / $964.06
| Professional | | $298.83 | $596.41 | $964.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.00 / $700.23 / $1,671.55
| Professional | | $310.00 | $700.23 | $1,671.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.00 / $6,079.00 / $9,624.00
| Facility | | $2,125.00 | $6,079.00 | $9,624.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.15 / $702.76 / $1,681.77
| Professional | | $578.15 | $702.76 | $1,681.77 |